Edward S. Bennett
In recognition of Contact Lens Health Week, sponsored by the CDC, Primary Care Optometry News spoke with Edward S. Bennett, OD, MSEd, on how to talk to patients about annual exams, where they purchase lenses and lens hygiene.
Bennett is chair of the American Optometric Association’s Contact Lens and Cornea Section and professor and assistant dean for student services and alumni relations at the University of Missouri-St. Louis College of Optometry.
PCON: Can you offer any tips on how optometrists can convince their patients that they need to have an eye exam at least once a year?
Bennett: The most important factor will be to emphasize to them that most sight-threatening conditions – most notably glaucoma - are initially painless, and by the time they notice areas of vision loss it may too late to restore their vision. Certainly, with contact lens wearers, the risk of sight-threatening corneal ulcers (microbial keratitis) is always present, especially if patients over wear their lenses, do not dispose of their lenses and cases as recommended by their eye care practitioner, and do not return for their annual examination to ensure the lenses are fitting correctly and the eyes are healthy. If they awake with redness, blurred vision and discomfort, an eye infection could result in loss of vision due to corneal scarring.
PCON: Should optometrists ask, and how should they ask, their patients if they’re purchasing their lenses from a reputable source?
Optometrist should, in fact, ask patients where they obtained their contact lenses. If they were obtained without a valid prescription, they should be educated about the risks of sight-threatening eye infections. In fact, it has been found that contact lenses purchased over the Internet are four times more likely to result in causing an eye infection (Stapleton et al.).
The AOA Contact Lens and Cornea Section has two valuable resources to help educate patients and optometrists. The website, www.contactlenssafety.org, lists 50 commonly asked questions by consumers about contact lens safety, complete with answers and sources as provided by experts in the field. “Frequently asked questions about contact lens prescriptions” is about to be launched on the AOA Contact Lens and Cornea Section website and represents a very useful resource to help patients understand why contact lenses are prescription medical devices.
PCON: How should optometrists stress the importance of lens hygiene and cleaning?
Bennett: Optometrists and their staff should be proactive and repeatedly educate patients about proper care and hygiene. This begins at the initial dispensing visit as it pertains to using the indicated solutions – not tap water – to care for the lenses, and if the lenses are not daily disposable to clean them upon removal every night. They should be asked to repeat the key care steps to ensure their understanding. They should wash their hands with non-lanolin-containing soap prior to handling the lenses. At both the all-important 1-week follow-up visit as well as future visits, they should be asked if they have any problems with handling, cleaning and caring for the lenses as well as confirm they are not over wearing the lenses as well as disposing of them as recommended.
PCON: What’s a good way to approach the topic of sleeping in contact lenses?
Bennett: I think it’s important to emphasize that the eye receives much less oxygen if you wear them during sleep and it can then “swell.” Over time this can result in a serious eye infection that can cause scarring of the cornea and permanent vision loss. This terminology is especially important to use if you do not want them to wear the lenses overnight or you suspect noncompliance.
It is important to mention the “Dr. Stan Yamane Triad”: Ask patients to check every morning to see if their eyes “see good,” “feel good” and “look good.” If there is redness, pain or poor vision they should call your office. You can also give them the link to www.contactlenssafety.org to gain a greater understanding of what problems can occur with overnight lens wear and why.
PCON: Do you have any other advice on promoting healthy contact lens wear?
Bennett: It is important for everyone to understand that noncompliance with proper contact lens wear and care is too high. The recent Aug. 17 Morbidity and Mortality Weekly Report from the CDC found that contact lens wearers exhibited a range of 23% to 45% of the following contact lens hygiene risk behaviors: Failing to visit an eye doctor annually, sleeping or napping in contact lenses, swimming in contact lenses, replacing contact lenses at intervals longer than prescribed, and replacing cases at intervals longer than recommended.
Stapleton F, et al. Ophthalmology. 2008;115:1655-1662;doi:10.1016/j.ophtha.2008.04.002.